Senate Republican leaders have released a revised version of the Better Care Reconciliation Act (BCRA II), their efforts to repeal and replace the Affordable Care Act. BCRA II is identical to the original BCRA, with a handful of key differences:
• BRCA II retains several of the new taxes levied under ACA (most notably the additional 0.9% Medicare tax on joint income over $250,000 and the 3.8% tax on investment earnings for those with joint income over $250,000).
• Retaining these taxes provides funds that allow BCRA II to allocate significant new funds to the states for a variety of purposes. These new allocations include:
◦ Funds to help states stabilize state insurance markets and provide a range of subsidies to insurers and individual;
◦ Funds for research on addiction related to the substance abuse crisis; and
◦ Grants to states to support substance abuse treatment.
• BCRA II also allows insurance companies to offer new bare bones policies if the carriers also offer other plans that meet ACA requirements. These bare bones policies would be exempt from a number of consumer protections under current law (such as protections for people with preexisting conditions).
• BCRA II adds detailed provisions requiring that insurance companies apply minimum waiting periods (generally, of at least 6 months) to individuals who cannot prove that they have had continuous coverage.
• BCRA II also contains provisions that add to portions of the original BCRA that seek to make health savings accounts more attractive and that seek discourage consumers from purchasing insurance coverage that pays for abortion coverage.
• BCRA II also allows consumers to use federal tax subsidies to purchase catastrophic coverage.
The bill’s provisions are focused on appealing to political and ideological considerations. At this point it is not clear whether these changes will be enough to change Republican opposition to the bill or where this political saga will lead. Stay tuned.